Sunday, September 2, 2012

Back to School Morning Battles

Transitioning from summer to school is never easy. Getting
all of the kids out of bed, ready for school, and out the door on time can be a
challenge. While we’d all like to start the day with a “good” morning, if you
have school-aged kids, mornings can often turn into battlegrounds. Of course,
no one solution will work for every child or every family, but here are some tools
that you may find useful.

Get Enough Sleep

Make sure you child is getting enough sleep. Pre-school and
elementary aged kids need 11 to 12 hours of sleep. Middle and high school aged
kids need 10 hours of sleep. Set their bedtimes accordingly. A well-rested
child won’t be difficult to get out of bed, and they are much more likely to be
cooperative and move faster than a sleepy child.

Maintain a Consistent Sleep/Wake Routine

Try to have consistent sleep and wake times seven days a
week. Having different weekend schedules can make falling asleep and
waking up difficult during the week.

Try Melatonin

If your child is having difficulty shifting to a school time
sleep/wake schedule, and in particular, is having difficulty falling asleep at
the appropriate time, you might consider melatonin supplementation. Melatonin
is a hormone naturally produced by the body that helps regulate the sleep/wake
cycle. Some studies show that taking melatonin 30 to 60 minutes before you want
to fall asleep can help you fall asleep and help adjust your sleep schedule.
(It is often used to treat jet lag.) Clinically, I have seen good results with
melatonin. To help adjust your child’s sleep schedule, give them melatonin 30
to 60 minutes before the time you want them to fall asleep. Make sure they are
comfortable, relaxed, and in bed when you want them to fall asleep. Melatonin
will not knock them out, it just makes them feel sleepy and less alert. If they
are watching television, playing video games, texting, etc., you might miss the
boat. I recommend a melatonin dose of 0.5mg to 9mg. I would start with a low
dose and increase by 0.5 to 1mg every few nights until you notice it working
well. Some kids will respond at low doses and others may need high doses. I
would not give this supplement to any child under 7 years of age. I recommend
short term use of a couple weeks to a few months to help adjust your child’s
sleep cycle. If you have any concerns about taking a supplement, consult your
doctor. Melatonin is available as an over-the-counter supplement. Stick with a
reputable brand.

Use a Dawn Simulation Light

Another tool to help change your child’s sleep/wake schedule
and help kids wake up in the morning is a dawn simulation light. Light triggers
a hormonal response which naturally ends the sleep cycle and triggers the body
to wake up.A dawn simulation
light gradually brightens over the course of 30 minutes to 2 hours, depending
on the light and the setting, simulating sunrise and triggering the end of the
sleep cycle. You awaken gradually and gently unlike a jarring alarm clock with
can leave you groggy. Be sure and use this every morning at the same time
including weekends.At first, your
child may not be fully awake at the set wake up time, but they should at least
be in a lighter stage of sleep more prepared to wake up for the day. Over time,
if your child is getting a sufficient number of hours of sleep, they should be
able to wake up at the desired time using the light.

Allot an Appropriate Amount of Time for Getting Ready

Figure out the right amount of time for your child to get
ready in the morning. Pre-schoolers and early elementary kids don’t know how to
“rush”. They won’t really understand time-pressure and can be easily distracted
by other things. Trying to hurry them can often backfire. Conversely, teen-agers
may be willing to forego “primping” time and a hot breakfast to get 20 minutes
more sleep. Also consider the full array of personalities—some kids are easily
distractible and require more time, some kids care more about their appearance
and will require more time, some kids don’t care that much about appearance and
would rather sleep more, etc. Know your child and set their wake-up times
thoughtfully.

Be Ready Early

If you have pre-school or elementary aged kids, I recommend
that parents be fully ready (showered, dressed, etc.) before their kids wake
up. Preschool and early elementary kids aren’t going to necessarily plow
through their morning routine on their own in a timely fashion. Be prepared to
help them every step of the way to keep them on track, and to deal with those
meltdowns or burst of uncooperativeness that all kids seem to exhibit whenever
you’re watching the clock. For older elementary aged kids, be available if they
need you.

Write Down the Morning Routine

For pre-schoolers and early elementary, have a written
morning routine for your kids. This is basically a list of all the things they
need to do in the morning. Use pictures if your child can’t read. This list
helps set mutual expectations and provides a reference for your child. You can
even turn this into a check list or sticker chart to help motivate your child and create something tangible in which they can take pride.

Give Your Child Responsibility

By the time your child is in 2nd or 3rd
grade, you should take yourself out of the morning battle and put the
responsibility with your child. Agree upon a “morning contract”. The contract should
include wake up time, morning tasks, completion time, and clear consequences
for not being ready on time. It should also define clear consequences for not
being ready on time. Set your child up for success by giving them plenty of
time to complete their tasks. If possible, have logical consequences such as
going to bed earlier that night so they have energy and can concentrate in the
morning, or a monetary fine (your time is money and they are wasting it). Make
sure there are clocks or timers in their bedroom and bathroom so they can keep
track of time. Then, step back and let them take responsibility for their own
morning routine. Make sure you hold up your end of the bargain and give
consequences consistently.

Practice on the Weekend

If your child repeatedly demonstrates that they can’t get
ready on time, you can try a weekend practice session. When they get up on
Saturday morning, they can do their morning routine, then put their pajamas
back on, get back in bed, and do it all over again and again. Up front, specify
the number of times they will have to repeat the routine. Use a stopwatch so
you can see their progress and how long it takes if they are truly motivated
(but don’t expect average weekday times to come close to their fastest Saturday
practice session time). Sometimes children are uncooperative with their morning
routine because of strong anxiety about going to the school.

Arrive at School On Time Regardless

Younger children need to learn that they need to be there
when school starts. If you are allowing enough time and providing enough
support for your pre-schooler or early elementary child, and they are still
being uncooperative and are making themselves late for school, don’t let it
happen. Bring your child to school on time regardless. Drop them off in their
pajamas with their outfit in a bag. Be sure and let them know of this plan
ahead of time so they have the opportunity to correct the situation. Your child
may start kicking and screaming (literally) when they figure out that you
really plan to bring them to school in their pajamas. Stick to your guns. Get
help getting them in the car if necessary and be prepared to hand off a
screaming child to the school. It is a good idea to coordinate with the school
ahead of time so they are not surprised by your pajama-clad child. Most kids
will not arrive at school in their pajamas more than once.

Get Help From the School

If your older child is consistently late for school despite
your best efforts, talk to the school about their tardiness policy. See if they
will implement special measures for your child such as detention or curtailment
of extra-curricular activities based on tardiness. The school wants your child
to arrive on time, so you may find them very willing to help. Having the school
get involved takes some of the burden off of you and puts more responsibility
with the child.

Deal With Anxiety Head On

All kids have some anxiety about going back to school. Some
kids experience moderate to high levels of anxiety that can cause real
problems.Kids can demonstrate
high anxiety a number of ways. Some kids will be completely uncooperative with
the morning routine while trying to stall and delay (in which case, many of the
tools above won’t work), some will have stomach aches or other “illnesses”, some
will throw a tantrum when it is time to walk out the door or leave your side, or
you may find them literally kicking, screaming, and clinging to door frames as
they refuse to go to school.

The
first step is to talk with your child about their anxiety and find out what worries
them.As a parent, try to validate
their feelings. Don’t try to talk them out of their feelings or solve their
problems. In other words, do say things such as “I understand”, “having a new
teacher can be worrisome”, “being away from mommy can be scary”, etc. Don’t say
things such as “there is nothing to worry about”, “you’re just being silly”,
“don’t be a baby”, etc. Your child may have anxiety about something you can
address. For example, you might find out they are scared of the school bus,
they are bullied in the lunchroom, or they are confused about classroom
procedures. Most of the time, however, they will need to work out their
anxieties themselves.

As a parent, you need to validate their feelings but make
them go to school. Allowing them to stay home for a couple days to “get over
it” does not work and will probably make the problem worse. Your child needs to
deal with their anxieties as soon as possible. Get them to school by whatever
means necessary and be prepared to hand off a crying child to the school. This
advice holds true for preschoolers as well as older children. Preschoolers
often cry with varying intensity when being dropped off at school but usually
snap out of it shortly after you leave. Try to make your goodbye short and
sweet. Long drawn out emotional goodbyes will only make it harder for them and
you. Older kids can have a variety of reactions including physical refusal,
angry desperate crying, and silent tears. Leaving them at school in distress
can be incredibly hard, but know that in the long run you are making the best
decision for them. Obviously, you will need to work with the school to monitor
their progress. If your child continues to be in distress, you can try a
graduated plan where they go to school for a short amount of time and them come
home. Each day you send them to school a little longer. Make sure that when
they are home, they are doing schoolwork during school hours. Don’t let them
watch tv to do something fun during school hours. If your child seems extremely
anxious (i.e., freaking out) prior to the start of the school year, you can try
this graduated plan from the beginning. The only way to get over anxieties is to deal with them. You
have the difficult job of forcing your child to do this.

Social Anxiety Causing School Anxiety

One cause of school anxiety is social anxiety. Social
anxiety is significant emotional distress or fear about interacting with others
or about being watched or judged. This type of anxiety runs deeper than school and
is likely to have broad impacts on your child’s life beyond going to school. It
can impact your child’s ability to make and keep friends, it can hold your
child back from trying activities and having new experiences, and it can
ultimately impact their self-esteem. If you believe your child suffers from
social anxiety, I recommend that you seek help from a qualified mental health
professional.

Other Medical Issues Impacting Sleep

There are a few medical issues than can impact a child’s
ability to get up and get ready for school. If you feel your child may suffer
from one of these conditions, please consult your doctor.

POTS, or Postural Orthostatic Tachycardia Syndrome, is a
condition in which the blood vessels don’t respond properly to changes in
gravity resulting in rapid jumps in heart rate. As a result, most kids with
this problem will experience lightheadedness when going from sitting or laying
to standing, standing for a prolonged period of time, or taking a hot shower. Children
with this condition may also be prone to fainting, complain of frequent
headaches, have low energy, and have difficulty waking up in the morning. This
problem tends to occur more often in girls and most commonly begins during the
teenage years. If your child is experiencing some of these symptoms you should
check with your pediatrician. A referral to a pediatric cardiologist for a simple
non-invasive test may be necessary to help diagnose this condition.

Delayed Phase Sleep Syndrome is a sleep disorder in which
people have a delayed sleep-wake schedule. They aren’t able to fall asleep
until very late at night (typically about 2am or later) but can then sleep a
normal amount of time and get restful sleep. This condition is problematic because
school and starts at about 7am, not noon. This problem typically starts around
puberty when there is a natural shift in the sleep-wake cycle. Obviously, kids
with this sleep disorder have a terrible time waking up for school. They are
just too exhausted from having fallen asleep just a few hours prior to you
waking them. In general, the treatment will require use of a light box,
melatonin and other means to help shift the sleep-wake schedule to an earlier
bedtime. Once a normal sleep/wake schedule is achieved, these teens will need
to very strictly adhere to the schedule seven days a week to main the timing of
the sleep cycle. Please consult your doctor if you feel you child is suffering
from this condition.

Sleep Apnea is a condition in which children (or adults)
wake multiple times during the night due to breathing obstructions. Usually,
people with this condition are not aware that they are waking up. In kids, this
condition is often due to enlarged tonsils or adenoids partially blocking their
airway. Children with this condition do not get a good night’s sleep despite
having slept for an appropriate duration. They will consistently be difficult
to wake up and be tired throughout the day. One way to tell if your child is
experiencing this problem is to watch and listen to them while they sleep. If
they snore loudly, if their breath seems to “catch” while snoring, or if they are
snoring and don’t seem to be sleeping soundly, they may have this problem. Consult
your pediatrician if you think your child suffers from sleep apnea. Consider
making an audio or video recording of your child sleeping and bring it with you
to the doctor.

Unfortunately, there is no silver bullet to get you through
the morning routine peacefully and efficiently. Every child and family
situation is different and no single strategy works for everyone. I hope you
will find some of my suggestions helpful. Just remember that kids are kids, so
don’t expect perfection. If you try out a new approach, be sure and explain it
to your child, apply it consistently, and give it time to work. Good luck!

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ABOUT ME

I'm a board-certified adult and child & adolescent psychiatrist practicing in McLean, VA. I appear every Wednesday on NBC Washington News4 Midday to discuss a timely mental health topic, and I am a regular contributor on NBC's Today Show and MSNBC. Check out my website at www.joshuaweinermd.com.

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Any advice or recommendations that I provide in my blog are generalized based on my experience in my psychiatric practice and may not be appropriate for your situation. You know your situation best and are in the best position to determine if and how any advice or recommendations should be applied. If you face an urgent situation, please seek help from a qualified mental health professional.